@article{ref1,
title="Childhood household dysfunction and risk of self-harm: a cohort study of 107 518 young adults in Stockholm County",
journal="International journal of epidemiology",
year="2016",
author="Björkenstam, Emma and Kosidou, Kyriaki and Björkenstam, Charlotte",
volume="45",
number="2",
pages="501-511",
abstract="BACKGROUND: Childhood household dysfunction (CHD) is a risk indicator for self- harm in young adulthood. However, less is known about the effects of cumulative exposure to CHD and the role of school performance and childhood psychopathology in the relationship. <br><br>METHODS: We used a Swedish cohort of 107 518 individuals born in 1987-91. Register-based CHD indicators included familial death, parental substance abuse and psychiatric morbidity, parental somatic disease, parental criminality, parental separation/single-parent household, public assistance receipt and residential instability. Estimates of risk of self-harm from age 15 [measured as registered diagnosis of self-harm according to the International Classification of Disease (ICD)] were calculated as hazard ratios (HR) with 95% confidence intervals (CIs). <br><br>RESULTS: CHD indicators, with exceptions of familial death and parental somatic disease, were associated with an increased risk of self-harm. Accumulating CHD indicators increased the risk of self-harm in a graded manner, and individuals exposed to five or more indicators had a f5-fold risk [hazard ratio (HR): 4.9, 95% CI 3.8-6.4) after adjustment for school performance, childhood psychopathology and confounders. Exposure to five or more CHD indicators and poor school performance conferred a 20-fold increased risk, compared with non-exposed individuals in the highest grade group. The risk was elevated by 9-fold for those with five or more CHD indicators and a history of childhood psychopathology. <br><br>CONCLUSION: Childhood household dysfunction is associated with the risk of self-harm in young adults, particularly when accumulated. The risk is markedly increased in the subgroup of disadvantaged children that fail in school or develop childhood psychopathology.<br><br>© The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.<p /> <p>Language: en</p>",
language="en",
issn="0300-5771",
doi="10.1093/ije/dyw012",
url="http://dx.doi.org/10.1093/ije/dyw012"
}